Smith, Angela (2010) An interpretative phenomenological analysis of post traumatic growth in ...

218 Pages·2017·2.51 MB·English

by  Christine Middleton

University of Nottingham
Institute of Work, Health and Organisations

Doctorate in Clinical Psychology

2009/2010

An Interpretative Phenomenological Analysis of Post-traumatic
Growth in Adults Bereaved by Suicide

Angela Smith
Submitted in part fulfilment of the requirements for the Doctorate of
Clinical Psychology
Page 1 of 217

Acknowledgments
I would like to take the opportunity to acknowledge the support all those
associated with the University of Nottingham Doctorate of Clinical Psychology.
Special thanks go to Professor Stephen Joseph and Dr Roshan das Nair for
their time and encouragement of critical thinking which will stay with me
throughout my research career.
Volunteers from „Survivors of Bereavement by Suicide‟ and „Samaritans‟:
Caroline Simone, Eric Thwaites and Richard 1326, were invaluable in their
encouragement and enthusiasm for this project.
I would like to thank all those who kindly proof-read and made comments on
draft sections of this work. These include: Amanda Campbell, Elaine Cleworth,
Geoff Cleworth, Christine Collinson, Kate Harris, Stephen Joseph, Julien Louys,
Roshan das Nair, Jonathan Pearson, John Robertson, and Rachel Tomlins.

Wholehearted thanks to all the participants who offered their time and spoke
openly and honestly about their intimate feelings. Without their contributions
this work would not have been possible. Truly, thank you.

On a personal level, I would like to take the opportunity to thank KaManda. I
sincerely believe I would not have survived this process without your support,
encouragement, eternal organisation and, of course, ANTM. I will forever be
grateful.

I look forward to properly reuniting with all my friends whom I abandoned in
the process of completing this work: Rach, Sooz, and The Girls. I thank them
for their patience at my absence and each of their individual contributions to
my journey.

I wish to thank my family: Granddad, Mum, Geoff, and Pip who have tolerated
my stress, emotional load and psychological verbosity with unwavering love
and support. You will always keep me grounded and remind me of what really
counts.

Dad and Mike – I do not agree with your decisions, however without them I
would not have wanted to do this work, grown grateful for the life, friends and
love I have, nor truly know myself. You‟ll forever be in my heart, seen daily by
my own positive growth.
Page 2 of 217

Contents
Contents ............................................................................................. 2
List of Tables ....................................................................................... 3
List of Figures ...................................................................................... 3
List of Appendices ................................................................................ 4
Thesis Abstract .................................................................................... 5
Statement of contribution ...................................................................... 6
Article for submission to the “The Journal of Loss and Trauma” .................. 7
Extended Paper .................................................................................. 46
Background ............................................................................................................................... 46
Method ........................................................................................................................................ 67
Results ...................................................................................................................................... 101
Discussion................................................................................................................................ 132
References: ..................................................................................... 159
Appendices ...................................................................................... 181

Article word count: 5765 (Exc. Figures/tables/references/ [Further
discussion: extended paper] and [Appendix _ ] = 235) = 5550
Extended paper word count: 28, 853
Total Thesis word count: 34,403
Page 3 of 217

List of Tables
Pages:
Table 1 – Participants, their relationship to the deceased, 16
and the time since the suicide.
Table 2 – Codes used in transcription 90
List of Figures
Pages:
Figure 1 – Illustration of the overlaps between 18
superordinate and ordinate
Figure 2 – Basic flow chart of research procedure 82
Figure 3 – Illustration of how additional themes related to 107
previously described themes.
Page 4 of 217

List of Appendices
Appendix Title Page:
Appendix A Instructions for Authors for the „Journal of Loss and 181
Trauma
Appendix B Ethical approval letter from IWHO, University of 183
Nottingham.
Appendix C IWHO approval for „informal letter‟ requested by 184
SOBS.
Appendix D IWHO approval for amendment to protocol to utilise a 185
transcriber for three interviews.
Appendix E Invitation to participate 186
Appendix F „Informal letter‟ requested by SOBS 190
Appendix G Approval from the Board of Trustees at SOBS. 191
Appendix H Consent Form for participants 192
Appendix I Lone worker policy for the University of Nottingham 194
Appendix J Transcriber declaration of confidentiality. 195
Appendix K Participant transcription consent form 196
Appendix L Initial extract from Reflective Diary 197
Appendix M Transcript extracts indicating themes discarded due to 199
not being related to growth
Appendix N Section of audit trail from transcript through to themes 203
for Participant 2.
Appendix O Final spider diagram and reflective diary extract. 212
Appendix P Extracts from reflective diary 214
Appendix Q Adapted from Rolfe et al.‟s (2001) Reflective model. 216
Page 5 of 217

Thesis Abstract
This thesis explored the experiences of post-traumatic growth in adults
bereaved by suicide. Past literature into posttraumatic growth,
posttraumatic growth in bereavement and bereavement by suicide is
examined to rationalise the current research. There is critique of the
methodologies used in the past literature.
The epistemological stance of the current research and justification of
the qualitative approach to the current study is examined. Six
participants were interviewed using a semi-structured interview
schedule. Transcribed interviews were analysed from an interpretative
phenomenological framework.
Two superordinate themes, with three ordinate themes in each, were
identified: (1) Positive growth: „life view‟, „knowledge of self‟, and
„relation to others‟; (2) Social perception: „gaze of others‟, „public guise‟,
and „solace of other survivors‟. These are presented and discussed
within the journal article. Three additional ordinate themes were
identified: (3) Process of time, (4) Bereavement stages and, (5) New
normal, which are presented in further detail and discussed in the
extended paper.
The results yielded that some suicide survivors gain extra characteristics
and insights due to their experiences, but are reluctant to acknowledge
that they do. These results are discussed with reference to previous
literature, and the epistemological stance of the research. A critique of
the current research is provided before recommendations for research
are outlined. The thesis concludes with the researcher‟s critical reflection
on some of the theoretical, scientific and ethical considerations made
during the process of the research.
Page 6 of 217

Statement of contribution
1. Project design:
Angela Smith (with supervision from Roshan das Nair and Stephen Joseph)

2. Applying for ethical approval:
Angela Smith (with supervision from Roshan das Nair and Stephen Joseph)

3. Writing the literature review:
Angela Smith (with supervision from Roshan das Nair and Stephen Joseph)

4. Recruiting participants:
Caroline Simone and Eric Thwaites (Survivors of Bereavement by Suicide
Trustees), and un-named group facilitators disseminated the „Participant
Information Packs‟ to group members. Richard 1326 (Samaritans) placed a
„Participant Information Pack‟ into the Samaritan‟s „Branch book‟

5. Data collection:
Angela Smith

6. Transcription:
Participants 1 – 3: Angela Smith, Participants 4 – 6: Carol di Cello
(Transcription Services)

7. Analysis:
Angela Smith (with supervision from Roshan das Nair and Stephen Joseph)

8. Write up:
Angela Smith (with supervision from Roshan das Nair and Stephen Joseph)
Page 7 of 217

Article for submission to the “The Journal of Loss and Trauma”

An Interpretative Phenomenological Analysis of Post-traumatic
Growth in Adults Bereaved by Suicide
(Shortened „running head‟ title: Lived experience: Growth in suicide bereavement)
(Guidance for authors can be found in Appendix A)

Angela Smith1*, Stephen Joseph2 and Roshan das Nair3

1Trent Doctorate in Clinical Psychology, University of Nottingham, UK.
2Department of Sociology and Social Policy, University of Nottingham, UK.
3Institute of Work, Health and Organisations, University of Nottingham, UK.

*Requests for reprints should be addressed to:
Angela Smith, IWHO, International House, Jubilee Campus, University of Nottingham.
Nottingham. NG8 1BB Email: [email protected]
Page 8 of 217

This study explored the experiences of post-traumatic
growth in adults bereaved by suicide. Six participants
were interviewed using a semi-structured interview
schedule. Transcribed interviews were analysed from an
interpretative phenomenological framework. Two
superordinate themes, with three ordinate themes in
each, were identified: (1) Positive growth: „life view‟,
„knowledge of self‟, and „relation to others‟; (2) Social
perception: „gaze of others‟, „public guise‟, and „solace of
other survivors‟. Suicide survivors gain extra
characteristics and insights due to their experiences, but
are reluctant to acknowledge that they do. This requires
consideration in theoretical and clinical settings.
Post-traumatic growth (PTG) is the term used to describe the
heightened levels of personal development that can be achieved after
trauma (Linley & Joseph, 2004). While the majority of research into PTG
has investigated survivors of illness, accidents, and disaster, a small
body of research has developed into bereavement as a trigger to PTG
(e.g., Davis, Nolen-Hoeksema & Larson, 1998; Parappully, Rosenbaum,
van den Daele & Nzewi,2002; Park & Cohen, 1993; for a review see
Schaefer & Moos, 2001; Yalom & Lieberman, 1991). No research has yet
Page 9 of 217

examined the lived experiences of PTG in bereavement by suicide. (For
more in depth descriptionsee extended paper – Background [A])
In 2006, 5,554 adults (aged 15 years+) took their own lives in the UK
(Office for National Statistics, 2008). It has been suggested for every
person who dies by suicide there are at least six people significantly
affected by that death (e.g. Pompili et al, 2008). McGlothlin (2006)
reported 4.5 million people are impacted by the suicide of a loved one
each year, leading to complex grief responses (McMenamy, Jordan &
Mitchell, 2008; Melhem, Day, Shear, Day, Reynolds & Brent, 2004),
prolonged depression, post-traumatic stress symptoms (Melhem et al,
2004), poorer physical health (Shepherd & Barraclough, 1974), stigma
(Cvinar, 2005), guilt and blame (Van Dongen, 1993; Silverman, Range
& Overholse, 1995) and an increased risk of their own suicidal intent
(Andriessen, 2005; Callahan, 1996) or completed suicide (Calhoun,
Selby & Selby; 1982; Melhem et al; 2004; Pompili et al; 2008). In light
of this research, it would be less expected for PTG to arise in
bereavement from suicide compared to other traumatic experiences.
However, a recent study asserted that personal growth represents an
important part of healing in parents who have lost a child to suicide
(Feigelmen, Jordan & Gorman, 2009). But as this was a large-scale
questionnaire-based study it was not able to explore in depth what
actually constituted growth for people bereaved by suicide. Therefore